Healthcare Provider Details

I. General information

NPI: 1811162977
Provider Name (Legal Business Name): GRELL ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 MASSACHUSETTS AVE
SAINT CLOUD FL
34769-3787
US

IV. Provider business mailing address

3249 NEWGATE CT
DUBLIN OH
43017-2223
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-3831
  • Fax: 407-892-7120
Mailing address:
  • Phone: 614-718-0093
  • Fax: 614-718-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL245
License Number StateFL

VIII. Authorized Official

Name: PAUL CHRISLER ELLINGSWORTH
Title or Position: PRESIDENT
Credential:
Phone: 614-718-0093